Michael A. Siegel

Effect of an antimicrobial mouthrinse on recurrent aphthous ulcerations.

Recurrent aphthous ulceration (RAU) remains a clinical problem for many patients. Efforts in prevention and/or treatment with prescription and nonprescription formulations have to date resulted in minimal success at best. A 6-month double-blind clinical study of 96 adults compared a commercially available antimicrobial mouthrinse (Listerine Antiseptic [LA], Warner-Lambert Co., Morris Plains, N.J.) and a hydroalcoholic control to evaluate the effects of vigorous twice-daily rinsing on the incidence, duration, and severity of RAU in persons prone to this disorder. LA rinse and the hydroalcoholic rinse resulted in a statistically significant reduction in the incidence of RAU occurrences from baseline. The duration of lesions and the severity of pain in subjects with ulcers during the treatment period were also significantly reduced in the LA rinse group of patients when compared with baseline. The hydroalcoholic rinse did not show a significant effect versus baseline for either severity or duration of the lesions. Rinsing therefore can be of clinical value in reducing the occurrence of RAU in susceptible patients, and LA rinse can be of significant additional value in decreasing the duration and severity of RAU.

VIRAL AND FUNGAL INFECTIONS OF THE ORAL CAVITY IN IMMUNOCOMPETENT PATIENTS

Oral lesions are easily visualized and often are signs of systemic diseases. Clinical diagnosis of viral and fungal infections can sometimes be confusing because many lesions will have similar clinical presentations. This article reviews the more common viral- and fungal-associated lesions found in the oral cavity in immunocompetent individuals. Differential diagnoses for the oral lesions are discussed and treatment options are proposed.

Cryopreserved amniotic membrane for modulation of periodontal soft tissue healing: a pilot study

BACKGROUND The purpose of this randomized study is to evaluate cryopreserved amniotic membrane (CAM) for helping cicatrization and wound healing after dental implant surgery. Epithelialization, pain, infection, inflammation, and scarring were studied. METHODS CAM was placed in surgical wounds related to implant surgery. The extent of healing was evaluated by a masked investigator for lesion size, epithelialization, pain, infection, inflammation, and scarring. A clinical evaluation occurred at baseline, 72 and 144 hours, 2 weeks, and 1, 1.5, and 3 months. The results were compared to conventionally managed, similar lesions that were treated the same day in the same patient allowing each patient to serve as their own control. RESULTS This prospective randomized study showed statistically significant differences between experimental and control groups regarding cicatrization, wound healing, and pain. The effects of the membrane were statistically significant during the first 3 weeks of the study, and thereafter, the effects of the membrane for the two groups were equivalent. CONCLUSIONS CAM was effective in helping cicatrization and wound healing. CAM supported the growth of the epithelium and, thus, facilitated migration and reinforced adhesion. It also decreased the pain of subjects. Regarding dental implants, the use of CAM is not cost effective. New studies evaluating other oral conditions are encouraged.

Direct immunofluorescence of detached gingival epithelium for diagnosis of cicatricial pemphigoid. Report of five cases

The diagnosis of mucosal cicatricial pemphigoid is often problematic because of frequent false negative or equivocal biopsy results. We describe an immunofluorescent technique that uses detached gingival epithelium for diagnostic purposes when oral manifestations of cicatricial pemphigoid are suspected. Erythematous mucosa that is gently rubbed produces detached epithelium that is then submitted for direct immunofluorescence studies along with tissue acquired via conventional techniques. In the five cases reported, the detached gingival epithelium stained intensely for immunoglobulins and complement on the basilar pole of the basal epithelial cells. The donor sites healed without a resultant periodontal defect. This adjunctive biopsy technique offers the advantage of easily procuring gingival tissue with deposition of immunoreactants that are quite specific for the diagnosis of cicatricial pemphigoid.

Intraoral biopsy technique for direct immunofluorescence studies

A wedge biopsy technique is described for use when oral manifestations of vesiculoerosive disease are suspected. The resultant soft tissue specimens are submitted for both light microscopic and direct immunofluorescence studies. This technique offers the advantage of obtaining highly diagnostic, mirror-image soft tissue specimens from a single perilesional site while minimizing postsurgical morbidity to the patient.